I am a physician, financial planner, educator, and I love to tell great stories. The world is too complicated and doesn’t have to be that way. The goal for this blog is to bring simplicity to the two subjects I know best – financial planning and medicine.
My background - Med School at University of Mississippi and residency at the Medical College of Virginia. I taught at the University of Florida and worked in various emergency departments in the Jacksonville area.
In trying to find a financial planner, I went back to school for fun and found another passion. I founded Life Planning Partners, Inc. in 2004 and felt like I haven’t had a job since. I began sharing stories on the interplay of my two professions and am grateful for audiences all over the country who want to hear my message about medicine, money, and keeping it simple. Please join the conversation.

The Unknown Workaround To Healthcare.gov

At midnight at the beginning of October 1, I logged onto Healthcare.gov with gleeful anticipation. Throughout the evening on Twitter, healthcare writers joked how we would be responsible for bringing the web site down, all in satisfying our curiosity and the need to write an article. As we all know, it ended up not being a joke. The site went down immediately, and has been the subject of much ridicule since.

The worse part of this fiasco? We know millions of people want to shop for coverage, and they are unable to do so through healthcare.gov. On Friday, the administration announced a private firm would take over fixing the broken website and actually set a target date for the fix by the end of November. Because of the website delay, any penalties for not having insurance coverage have now been pushed to March 31, 2014, which should give people plenty of time to purchase their coverage.

But what if you want coverage by January 1st? There are two groups of people who are keenly interested in the availability of good health insurance coverage – those who are uninsured and those who are paying a lot of money for their current insurance. One fix that has been made to the healthcare.gov site? You can now see the plans and the cost of the plans. Many people who have individual insurance have discovered the plans through healthcare.gov are less expensive than their current plan and they want to make a switch. So What Is The Workaround since the website doesn’t work? YOU CAN USE A HEALTH INSURANCE AGENT TO BUY QUALIFIED INSURANCE.

The administration currently suggests four options:

Submitting an 11 page paper application that is very cumbersome and doesn’t really sign you up for coverage – there are no policies to pick from in the application and it appears all the paper application does is check your eligibility for tax credits.

Filling out the online application at healthcare.gov. It was announced by the White House this morning that the application is fully functional. Of course, it still doesn’t share information about the policies. And I just tried to log on at 1:30 p.m. EDT – the site is not working. Don’t over-promise and under-deliver.

Apply by phone at 1-800-318-2596. I tried this option Sunday. A young man answered shortly and was super-nice. He stated he would help me fill out the same application that is available online. It would then take one to two weeks to receive information about my plan choices. I already knew I did not qualify for premium tax credits and just wanted to know about the plans. He couldn’t provide this information to me.

For in person help, you are referred to a Navigator or certified application counselors. Bad news – they know just as much as anyone else, which is pretty much nothing. They will take your application, and as I stated in option #1, the only thing the application does is determine if you qualify for a premium tax credit. You still cannot sign up for a policy.

Only after I questioned him directly about my options, the kind healthcare.gov phone person told me that I can buy the plans available on healthcare.gov through a health insurance agent. He also suggested that I still complete the application through healthcare.gov or through a Navigator because I may qualify for assistance. I told him over and over that my income is over 400% poverty level, so I know I won’t qualify for assistance. He inadvertently was going to waste my time and some Navigator’s time.

HOWEVER, if you make over 400% poverty level, and have individual insurance coverage, you should look at the new policies. For many people, the new policies provide better benefits at a less expensive price. Talk to a health insurance agent near you for quotes. Right now, the agents can share with you all of the policy provisions, deductibles, and co-pays. On healthcare.gov, all you can see right now are the premium charges.

If your income is under 400% poverty level, you may qualify for premium tax credits to purchase insurance and MUST purchase your insurance from the exchange to receive the credit. The good news – insurance agents sell the exchange policies, and it is probably easier to go through an agent than it is to use healthcare.gov. The key – make certain you use a reputable agent, which I will discuss shortly.

The insurance costs the same for you whether you go through healthcare.gov or whether you go through an insurance agent. Yes, the agent gets paid to provide this service, and it doesn’t increase your premium – it is money the insurance company would have kept anyway.

Policies are also available off the exchange. These are all guaranteed issue, have all the essential benefits, and same pricing as policies on the exchange. You are still able to purchase HSA qualified plans, and they will meet the minimal essential coverage requirements. Policies without essential benefits that do not meet minimum standards will not be sold after December 31, 2013.

These options were verified by a local Florida insurance agent, Angie Koury Lieb of George Koury and Associates Insurance. Right now, her company is helping people with pricing, arranging policies for those over 400% poverty level, and keeping a list of everyone under 400% poverty level so they can provide assistance as soon as the exchange is functioning well. Ms. Lieb offers three points of advice for people using a health insurance agent:

Make certain the agent is reputable and licensed in your state.

Ask the agent to show you all of the policies available because that agent may have an incentive (such as bonuses) to offer one company’s policy over another company.

If you are in doubt, you can compare the policies on healthcare.gov with what your agent shares with you in regards to your options.

I have a feeling working with a reputable agent with years of training is a much better option than working with a Navigator who has to follow a script and who has just received minimal training. The administration would do well by adding a fifth option to healthcare.gov – call a reputable insurance agent.

*** Addendum – I was informed by one reader that some agents did not have access to policies. This may vary from state to state. Agents, please chime in and let us know your status! This is important for a lot of people.

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Will healthcare.gov be fixed so that our private info submitted is encrypted (because currently it is not and at risk to hackers and ID thieves)? And how are HSA accounts still qualified if those of us who had HSA s before ACA implementation were told we could no longer use them once ACA kicked in?

Out of curiosity, I would be interested in reading your source for healthcare.gov info not being encrypted. Obviously the site uses a secure “https” connection. Are you implying their database is not encrypted or the connection to the site?

As you said f you are not eligible for a subsidy then you do not have to go to the exchange.

1. If you have a group plan available, you stay on it. 2. If you have a non-group plan, check with the company. All of my companies that I work with in Florida are offering a 12/31 special renewal that will continue the plans all the way through 2014 3. In most states, if not all, 2013 health underwritten plans are available and just like in item 2, they will be good all through 2014 4. In most states, if not all, you may have a wider choice of plans outside the exchange including all the plans that are in the exchange for 2014 with all of the ACA benefits..

Just contact your health insurance company and if they are giving a big increase or not offering to extend your present plan then contact a State Licensed Independent Agent that is also certified on the exchange and have the agent show you your options.

To find out if you can get a subsidy, go to Kaiser Subsidy Calculator.

To get a look at plans available in your zip code for both 2013 and 2014, you can go to ehealthinsurance and get a side by side comparison of most plans available in most states. There is an “800″ number to make sure the plan that you are looking at satisfies the Minimum Essential Coverage. All of my plans in Florida do satisfy the MEC.

Every carrier is making you drop your plan next year on renewal. Maybe that is 12/31/14 but unless it’s a “grandfathered” plan you’re losing your plan. Obama said you won’t lose your plan,….period! That makes him an inept liar.

I don’t know what market in Florida is but I do know that in Florida all the carriers are changing all the plan designs on January 1st 2014 so that’s not letting you keep your plan either.

You also don’t mention that you can’t keep your group plan if your small employer says they’re dropping

You don’t mention that the rates are going up A LOT especially on individual plans and in particular for anyone who had a plan with an out of pocket in excess of $6,350.

You also don’t mention the rates are “informational only” and have no actuarial soundness.

My opinion is that this whole thing is a guise to wipe out the “system” and lead inevitably to single payer nightmare coverage.

Medicaid and Medicare are broke and have only been sustained over the years by cost shifting to private insurance. (Not to mention indigent care). Wipe out the private sector and you’ve lost your subsidy and then the rationing has to start. How is the government going to handle 10,000 people a day retiring and wanting their SS and their Medicare and expand Medicaid and give 39 million others a tax subsidy with severe rationing?

There is no way the government can continue running deficits in the trillions. We’re at 17 trillion now and counting. It’s ineptitude of the highest order.

Yes!!! Insurance agents and brokers can certainly help you with coverage inside the Exchagne and outside the Exchange. The government had a certification process that agents and brokers completed in the last few months to be authorized to help consumers with Exchange applications, subsidies, enrollment in insurance plans, etc. Of course, agents and brokers are already licensed to help you with health insurance that is outside of the exchange.

You have 3 avenues to enroll or seek help.

1. The Exchange itself. Good luck. There’s a website, a call center, and newly trained Navigators. However, the Exchange does not provide information on any policies that can be purchased privately (outside the exchange).

2. Each Insurance Company directly. Again, you can use a website or call a licensed insurance company employee to help you. If that insurance company sells policies ON and OFF the exchange, they will tell you about both types. However, each Insurance Company will provide information about its own policies only, and they will not tell you about the policies of competitor insurance companies.

3. A licensed, insured agent. An agent can do it all. If they are certified to use the Exchange, they can tell you about policies ON the exchange and also OFF the exchange in the Private Market. They can tell you about policies from all the major health insurers in your area. They can help you select a plan (unlike Navigators that are not allowed to do this), they can tell you if your Doctor is in-network, if your prescription is on the forumlary… They can help you pick the plan that fits your budget and your needs. They can talk to you about subsidies and what your net cost would be. They can help you with that dreaded Exchange application process, too. For many years, insurance agents have been doing side-by-side comparisons online, which is a feature the Exchange is now trying to duplicate. Just enter your zip code, family ages and up comes a list of plans and prices, with specific details just a click away. And….. (insert drum roll here)… those websites WORK! You can apply online, too. Call and 1-800 number and get a real live person with actual knowledge and experience. It works. Agents have been doing this for years, and we wonder why we needed an “Exchange” in the first place. It’s really just a gigantic federal insurance agency.

And, next, insurance agents/brokers come at no extra charge to you. That’s because the cost of ALL 3 of these types of helpers is built into the premium. Yes, the Exchange costs money. Each insurance company pays a fee to have their policies listed on the Exchange, and that fee is similar to the commission that an insurance agent gets for helping you. So, whether you buy get your insurance direct from the Exchange, direct from an Insurance Company or through a licensed and insured Insurance Agent or Broker, your cost is the same.

You’re right on all counts. But you and I both know the Dems want single payer and this is just a Trojan Horse to get them there. Good luck getting your commission from an exchange policy aka the government insurance agency.

I just want to point out one thing. There is no $95 penalty, it is higher.

It is $95 or 1% whichever is greater. If you are only eligible for the $95 penalty it means that you only made $9,500. That is lower than 100% of poverty which is $11,450 and you are either eligible for expanded Medicaid or in states that did not expand Medicaid you are exempt from the penalty.